I am new to the site and want to know about surgery options. I see a surgeon on Monday for my gerd. My LES was found to be wide open and i am looking for info about this. Is there anyway to strengthen it on my own or is surgery the only option for fixing this problem. Any advice would be appreciated.

Good Morning Monte and welcome to HealingWell.Normally the stomach contents are retained in the stomach by a valve called the Lower Esophageal Sphincter or LES for short. This valve opens to allow food to pass into the stomach when swallowing, and then closes to prevent the contents from re-entering the esophagus.

Surgical treatment has long been known to be a more permanent and effective treatment for GERD, with the most common surgical treatment being Nissen Fundoplication.

This brings us to the latest technology EsophyX the newest and most effective treatment for GERD. This pioneering new system developed by Endogastric Solutions Inc.uses trans-oral endoscopy techniques. Thus the instruments are passed through the mouth to the stomach using an endoscope

This clever device allows Gastroenterologists and Surgeons to mold what is essentially a new valve using a small section of the stomach tissue. The procedure is performed under general anaesthetic but involves no surgery; instead, an endoscope. Reference: Medical Dictionary 2006 Edition.

I wish you the best and hope you are able to talk through the pros and cons of the procedure with your GI Physician.

The LES doesn't get tightened by exercise like your tush or tummy might. If it's wide open, then it appears surgery would help. I had the Nissen Fundoplication last October and it was the best decision I ever made. I did discus the esophyx procedure with my surgeon and gastroenterologist and ruled it out as a good option for me. I wanted something long lasting. The esophyx procedure hasn't been around long enough for me to feel comfortable with it and my research showed it had to be redone after 2 years. I personally know people who had a Nissen 10 years ago and are not experiencing problems. I understand that the Nissen may have to be redone, but the 10 years sounded better than 2 years to me.

You'll find a ton of information on this board from people who have recently had the Nissen surgery. The subject lines are clearly noted so you won't have a problem finding them.

Thanks everyone for your info. To be honest I'm scared to have the lap nissan done because of the pre-tests, the recovery, and the side effects. I know I need to get it fixed but I was hoping that the new esophyx would be a good solution to my problem. I'm really confused at this point.

I had the Esophyx procedure 6 weeks ago. I had no side effects. However, it has not helped me. From what I have read, it has an 85% success rate. As with Nissen fundo, it is possible that people like myself with LPR (throatburn) are less likely to respond to any treatment, including Esophyx.

I just found out that i have LPR ( throatburn) too. I see a surgeon on Monday and I think I am going for the lap nissen because it has a higher success rate. I will let you know what the surgeon says on Monday.

Good luck with your Dr. visit. I hope he gives you encouraging information.

After I am completely healed, I was thinking of pursuing a lap Nissen. I just need to verify that it is possible to have one, after an esophyx procedure. I live in New Jersey. Do you mind if I ask what state your surgeon is in? Do you know how many lap Nissens he has performed and how many of his patients had LPR?

I'm sorry but i don't have any info yet. All i know is that the lap nissen has a higher success rate and since i don't want to do this twice i am going to have that done.

I'll know more by Monday evening. I live in Florida but i am from New York. My sister lives in Jersey. I know there are only a few doctors in the states that do the new esophyx procedure and all research says to get an experienced doc in order to have a greater success rate.

I'm sorry to hear that yours didn't work. Did the doc say what he thinks went wrong?

There are 3 doctors in the US that do the esophyx procedure. They are in Florida, NY and Ohio. My Dr. performed the procedure on 20 people prior to me, and he said they were all feeling better (either off meds, or had reduced their meds). He told me after the procedure that my LES valve was flat and that he created a new one with the endoscopic device. I also had a small HH which he reduced. He does not know why I did not improve. He recommended I have another Bravo pH test to investigate if I still have acid reflux. I just need to heal a bit more before I have it done.

I have an appointment with the one in FL on Monday at 2. What are your symptoms? are you still refluxing? How long did you have LPR before they decided on surgery? My doc has performed over 50 in the last 4 months but it is so new that we don't know how long it last and how well it fixes the problem. Would your doc tell you if the others were having issues also? It's a very tricky and confusing area.

It's nice to have someone to talk to that has the same diagnosis and i will keep you posted on progress. Here is my direct email ( is this allowed in this forum? i don't know)

I had the Esophyx procedure performed 6 mos ago. I am pleased to report that I am now feeling much better. It took 4 months for me to get to the point where I was able to get off all meds. I no longer take PPI's (I had been taking Nexium). I still have some LPR daily (throatburn), but it is VERY mild. I have had absolutely no side effects from this procedure and recommend it.

Wow Roseann.... I had you firmly in the "no" camp ? I'm so glad to hear that and thanks for sharing. I must say that I was getting a little (a lot) discouraged after reading the history of those who had it here. I've been seriously considering it for some time and am about to make a decision. I'm one of the lucky ones who had a Nissen done way back when and that needs a new repair. Haveing been through open surgery, I would gladly pay the money to have a similar resolution without another surgery.

Am I wrong in my assumption that things did not appear that successful at one time ? Whatever advice you would have for someone like me would be most welcome....

i had the esophyx performed a year ago and it failed,at the moment i`m 4 months post op nissen.i would not recommend a esophyx to you i think the hill repair would be better for you.dr.aye in Seatle is a great surgeon for the job.good luck to you.

Yes, you are correct. For many months, I did not experience any symptom improvement in my LPR. The one thing that did go away almost immediately after my Esophyx procedure, was the burning in my chest. However, that symptom had always been relieved with Nexium, whereas the LPR was never relieved with Nexium. Therefore, LPR symptoms were more distressing to me. What finally helped me was praacticing stress reduction techniques. I know that this is going to sound crazy, but I read advice on another GERD forum where someone was recommending meditation as a tool for reducing Gerd symptoms. I have never in my life practiced any meditation , but I do have a lot of stress in my life. So, I thought I would give it a try. I was skeptical but figured I had nothing to lose.

Then I recalled that several weeks prior to my esophyx procedure, my husband and I vacationed in Florida. I had absolutely no GERD symptoms while on vacation, despite drinking coffee every day and eating chocolate. My esophyx surgeon told me that prior to the esophyx procedure, my LES valve was flat. So I cant explain why I felt so good on vacation, other than stress being a major contributor to my symptoms. Currently, when my increase, I meditate for awhile and I feel better by the next day.

I have no idea how long the esophyx procedure will be effective for me, or even if a re-do is possible. I have read great things about Dr. Aye and the Hill Repair, but I live in NJ, and having surgery on the West Coast is not an option for me at my age (67). I am so sorry that I cannot be of more help. I wish you all the best with your decision. Do you know if they can perform Esophyx on patients who have had the Nissen?

My situation is different because I've been told that lap is not possible for me. I have scar tissue there from 2 prior surgeries. That's why Esophyx is the way to go if effective. The other difference is that my heartburn is pretty well restricted to night time. During the day, I can eat most things. After 4 pm- I'm better off not to be eating at all. This is pretty well what I do when things get bad- and they sometimes do. I'm best to have digested and to have stayed away from wine before going to bed.

As for the possibility of Esophyx after my Nissen, we're just waiting for the upper GI to determine that...

I agree about stress- I do much better when relaxed. It's a bit the chicken and the egg- nothing like being in pain for 3 nights to build up stress ? My best solution is fasting but it's not very practical : ).

Forgot to mention the scientific evidence that Esophyx helped me. I had endoscopy with 48 hr Bravo ph test performed both pre and post esophyx. Both tests were done after I had been off Nexium for 2 weeks. Pre esophyx indicated I had acid reflux...De Meester score was 38 (Day 1) and 32 (Day 2). Normal is less than 14.7. Post esophyx score was 5.2 on Day 1 and 12.9 on Day 2, indicating I no longer had an abnormal number of acid refluxes. Also, my operative report (post esophyx) says that the lower esophageal sphincter valve was recreated by forming a valve with the Esophyx device it also says that endoscopy "revealed that the valve was tight around the scope with a grade 1 Hill grade."

Interestingly, my LPR symptoms begin in the afternoon. I experience no symptoms at all within a few minutes after lying down, and during sleep. One would think that gravity would cause my throatburn to get worse at night, but its just the opposite.

BTW, an unaticipated benefit of my meditating is that my chronic lower back pain is MUCH better. I no longer have to see my chiropractor every week.

Well Roseann, I'm very happy to see your result is a good one. Mind if I ask where you had it done? I suspect that results depend greatly on the author so to speak... Did you weather the procedure well? Sadly, we hear from so few who have had it done, it's hard to get a fix on the success rate.

Your results certainly indicate a big difference post-op.... My Nissen was done in 1989 and it completely changed my life. I'm hoping for a similar result... it sure improved my quality of life for 16 years. Right now, it's pretty much day to day with Zantac and Tumms- PPI's just do not agree with me. Again, thanks for sharing. Rick

I had my procedure done in NY (out on Long Island at Mercy Medical Center in Rockville Center). I live in NJ. My surgeon was Dr. Shawn Garber. I did not know anyone who had used him, but there was no other Dr, in the North East, performing the procedure. I researched his background as best I could and found no negatives. He went to Europe to be trained in the esophyx procedure. He is a well respected bariatric surgeon with a very busy practice. His office is always filled with patients, which I take to be a good sign. He was on the Best Doctors in NY list. I found him to be very nice, curteous, and did not rush me at all. He answered every question I had and gave me a CD disc that explained the esophyx procedure, to view in my computer. I had absolutely no side effects from this procedure, except for a few days of a mild sore throat and mild shoulder pain. I did have to be on a graduated soft food diet for a few months, following the procedure, but it was easy to follow. There is now a Dr. in NJ performing the procedure, but Dr. Garber has much more experience. When I saw him he told me (because I asked him) that he had performed the procedure on 20 patients.

Good for you to have gone ahead then. I am not covered but if it works- I won't mind. The more procedures are done, the more likely a good result will follow. I will let you know what transpires once I get results back from upper GI.... this is very encouraging and welcome news. Rick

I wish you the very best with your decision. Please let us know what the outcome is. I think I mentioned in a previous posting that Dr. Garber told me that 85% of his post esophyx patients (N=20), were able to discontinue their meds. The remaining 15% were able to reduce it.

One more thought: if you decide to go ahead with the procedure, would it be worthwile for you to change health insurance company to one that covers Esophyx?

It's not quite that simple... I'm Canadian. Esophyx is considered experimental still... I could fight to get it accepted but that might take years and I can't wait that long. I can't complain, everything is covered for me in Canada and I've been treated very well up to now.My doctor in Florida is waiting on a barium xray to determined whether I'm a suitable candidate. If not- it's Nissen for me and covered in Canada. I will advise what happens. Thanks for your best wishes !

Now I understand why your health ins. does not cover. I am lucky that Medicare (government sponsered health Ins for those over 65) covered, because Medicare usually doesnt cover new procedures.

If you dont mind my asking, do you have any LPR symptoms, and were they helped by Nissen? My impression is that non-traditional heartburn symptoms such as LPR are less likely to be alleviated by meds or by any procedure.

No I can't say I have LPR....The Nissen done in 1989 completely eliminated any acid from the stomach comimg up. I could eat salsa and go to bed. Amazing, now that I think of it. No question, stress or no stress- it was gone. Most important for me- was the undisturbed sleep which almost never happens anymore. So, the re-construction of the LES is of prime importance for me. No matter what I do now- I always wake up- sometimes to spend 2 or 3 hours up in the middle of the night. Sleep is what this is all about for me, and hopefully it's a permanent solution- or as permanent as a 57 year old can ask for : ).